Type 1 Diabetes Guide
A picture-led handbook for children and families
How to use this booklet
Read one chapter at a time. Ask your diabetes educator to demonstrate each skill, then tick it when you can do it safely.
| Chapter | What you will learn |
|---|---|
| 1 | What type 1 diabetes is |
| 2 | How to check a finger-prick glucose |
| 3 | How to complete a 7-point profile |
| 4 | Types of insulin |
| 5 | Giving, storing and rotating insulin |
| 6 | Food groups and carbohydrate counting |
| 7 | Recognizing and treating hypoglycemia |
| 8 | Hyperglycemia and ketones |
| 9 | Sick-day management |
| IMPORTANT | |
| This booklet supports - but does not replace - your child’s written insulin, correction, ketone and sick-day plan. Insulin doses must | |
| be individualized by the diabetes team. |
CHAPTER 1
1. What is type 1 diabetes?
Food is broken down into glucose. Glucose travels in the blood and is a major fuel for the body. Insulin is the “key” that helps glucose move from the blood into cells.
| What normally happens | What happens in type 1 diabetes | What treatment does |
|---|---|---|
| The pancreas releases insulin so | The immune system damages insulin- | Injected or pumped insulin replaces the |
| glucose can enter cells. | making beta cells. | missing insulin. |
IT IS NOT YOUR FAULT
Type 1 diabetes is not caused by eating sugar, being inactive, or anything a child or parent did. It cannot be prevented by diet alone.
THE DAILY BUILDING BLOCKS
Take insulin • check glucose • count carbohydrate • play and exercise safely.
CHAPTER 2
2. How to check blood glucose
| 1 | Wash and dry hands Food or moisture on fingers can alter |
|---|---|
| the reading. |
| 2 | Prepare Insert an unexpired strip and load a fresh lancet. |
|---|
| 3 | Prick the side of a fingertip Avoid the centre pad; rotate |
|---|---|
| fingers. |
| 4 | Apply blood Let the strip draw in the drop. Avoid forceful |
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| squeezing. |
| 5 | Read, record and act Write the number, time, insulin, |
|---|---|
| food, activity and symptoms. |
METER SAFETY
Never share lancets or finger-pricking devices. Dispose of sharps in a puncture-resistant container. Confirm with a meter if symptoms do not match a CGM reading.
CHAPTER 3
3. The 7-point sugar profile
A 7-point profile shows how meals and insulin affect glucose across one day. Use it on days advised by your diabetes team.
| Point | Time | Record beside it |
|---|---|---|
| 1 | Before breakfast | Overnight/basal pattern |
| 2 | About 2 h after breakfast | Breakfast and bolus effect |
| 3 | Before lunch | Morning trend |
| 4 | About 2 h after lunch | Lunch and bolus effect |
| 5 | Before dinner | Afternoon trend |
| 6 | About 2 h after dinner | Dinner and bolus effect |
| 7 | At 3 am | Overnight safety |
| EXTRA CHECKS | ||
| Check additionally when symptoms occur, before/during/after exercise, during illness, after treating a low, and at 2-3 am when | ||
| your team advises. CGM may reduce finger-pricks, but keep a meter available. |
CHAPTER 4
4. Types of insulin
Most children use a basal-bolus plan: background insulin plus meal insulin. Pumps use rapid-acting insulin continuously. Exact timing depends on the prescribed product.
| Type | Main job | Typical start / duration* | Examples (generic) |
|---|---|---|---|
| Ultra-rapid / rapid | Meals and corrections | ~5-20 min / ~3-5 h | lispro, aspart, glulisine |
| Short-acting | Meals | ~30 min / ~5-8 h | regular/soluble insulin |
| Intermediate | Background; has a peak | ~1-2 h / ~12-18 h | NPH/isophane |
| Long-acting | Background | ~1-2 h / up to ~24 h | glargine U100, detemir |
| Ultra-long | Background | varies / >24 h | degludec, glargine U300 |
*Approximate profiles vary by dose, injection site, activity, age and product. Follow the label and your diabetes team.
BASAL + BOLUS
Basal insulin covers glucose made between meals and overnight. Bolus insulin covers carbohydrate eaten and may correct high glucose. Do not swap insulin types or concentrations without checking.
CONCENTRATION WARNING
Use only the device intended for that insulin concentration. Never withdraw insulin from a pen cartridge with a syringe.
CHAPTER 5
5. Giving insulin safely
| 1 | Check Right child, insulin, concentration, dose and time. |
|---|---|
| Check label and expiry. |
| 2 | Prepare the pen Attach a new needle. Prime according to |
|---|---|
| device instructions. Dial the prescribed dose. |
| 3 | Choose healthy tissue Avoid lumps, scars, bruises and |
|---|---|
| inflamed skin. Use clean, dry skin. |
| 4 | Inject into subcutaneous fat Use the needle length and |
|---|---|
| skin-fold technique taught by your team. |
| 5 | Count slowly Keep the needle in place for the device- |
|---|---|
| recommended time (often 10 seconds), then remove safely. |
| 6 | Dispose and record Remove the needle from the pen and |
|---|---|
| place it in a sharps container. |
CHAPTER 5
5. Storage, rotation and precautions
| DO | AVOID |
|---|---|
| Keep unopened insulin refrigerated at 2-8°C; store it in the | Never freeze insulin or place it beside the freezer plate. |
| main compartment. | |
| Write the opening date on in-use insulin; follow its leaflet for | Avoid direct sun, heat, parked cars, expired insulin or |
| time and temperature limits. | unexpected clumps/discolouration. |
| Travel with insulin in an insulated pouch and keep it with you. | Do not let insulin touch ice or a frozen pack directly. |
| ROTATE, DO NOT RANDOMLY JUMP | |
| Use one region consistently for the same time of day, but move each injection at least one finger-width. Examine sites regularly. | |
| Injecting into lipohypertrophy makes absorption unpredictable. |
CHECK THE LEAFLET
In-use temperature limits and discard times differ between products (often around 28 days, but not always). Follow the manufacturer’s leaflet and your team’s written instructions.
CHAPTER 6
6. Food groups and the healthy plate
Children with type 1 diabetes need normal growth, variety and family meals - not a “diabetic diet”. Match insulin to carbohydrate using the individualized insulin-to-carbohydrate ratio.
| Half the plate | One quarter | One quarter | Add |
|---|---|---|---|
| Non-starchy vegetables: leafy | Protein: dal, pulses, paneer, egg, fish or chicken | Carbohydrate: roti, rice, bhakri, idli, poha or other grain | Water; fruit or dairy as planned |
| vegetables, beans, carrot, | |||
| cucumber |
Count carbohydrate in grains, potato/corn, fruit, milk/yogurt, dal/beans, sweets and sweet drinks. Most non-starchy vegetables, eggs, fish and chicken contain little carbohydrate.
QUALITY STILL MATTERS
Prefer whole grains, pulses, vegetables, fruit and unsweetened dairy. Limit sugary drinks, highly processed snacks and excess saturated fat. Do not unnecessarily restrict carbohydrate in a growing child.
CHAPTER 6
6. Carbohydrate counting
Carbohydrate counting estimates the grams of carbohydrate in a meal. Use household measures, food labels and a digital kitchen scale while learning.
| 1 | List carbohydrate foods Example: chapati + dal + milk. |
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| 2 | Measure the portion Use the same cup, bowl or scale. |
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| 3 | Find carbohydrate grams Use your approved exchange list or nutrition label. |
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| 4 | Add the grams This is the meal’s total carbohydrate. |
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| 5 | Calculate meal insulin Use only the insulin-to-carbohydrate ratio prescribed for that time of day. |
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| Approximate 15 g carbohydrate exchange | Portion from the supplied diet guide |
|---|---|
| Chapati | 1 |
| Cooked rice | ⅓ cup |
| Bread | 1 slice |
| Roasted chana | ⅓ cup |
| Apple | 1 small |
| Banana | 1 small |
| Milk | 250 mL |
| Dhokla | 2 pieces |
| VERIFY PORTIONS | |
| Recipes, bowl sizes and brands vary. These are learning estimates from the supplied diet booklet, not universal values. Check | |
| labels and review portions with your dietitian. |
CHAPTER 7
7. Hypoglycemia (low sugars)
Hypoglycemia or low sugar is sugar level below 70 mg/dL (3.9 mmol/L). Treat promptly. A child may have low sugars even before a meter result if typical symptoms occur.
| Body warning signs | Brain/behaviour signs |
|---|---|
| Shaking, sweating, hunger, paleness, fast heartbeat | Irritability, headache, confusion, poor concentration |
| Tingling, weakness, dizziness | Unusual behaviour, drowsiness, blurred vision |
| Nightmares or restless sleep | Seizure or unconsciousness = severe hypoglycemia |
IF CONSCIOUS AND ABLE TO SWALLOW
Give rapid glucose: ISPAD recommends about 0.3 g/kg, usually not more than 15 g. Examples include measured glucose tablets/gel or glucose dissolved in water. Recheck in 15 minutes and repeat if still below 70 mg/dL. Follow with the planned meal/snack when appropriate.
IF UNCONSCIOUS, SEIZING OR UNABLE TO SWALLOW
Do not give food or drink by mouth. Place on the side, give prescribed glucagon immediately, call emergency services, and recheck glucose. Family and school staff should practise the glucagon plan.
CHAPTER 8
8. Hyperglycemia and ketones
Hyperglycemia means glucose is above the child’s target. Common causes include missed or insufficient insulin, illness, stress, inaccurate carbohydrate counting, spoiled insulin, injection-site problems, or pump/set failure.
| High-glucose symptoms | Danger signs of DKA |
|---|---|
| Thirst, frequent urination, tiredness, blurred vision | Vomiting or severe abdominal pain |
| Dry mouth, headache, poor concentration | Deep/rapid breathing or fruity-smelling breath |
| Often no symptoms - check glucose | Increasing drowsiness, confusion or dehydration |
When to check ketones
Whenever the child is unwell, especially with fever, vomiting, abdominal pain or unusual tiredness - even if glucose
is not very high. When glucose is persistently high (commonly ≥300 mg/dL / 14.2 mmol/L, or the threshold in your written plan). When a pump or infusion-set problem is suspected.
What to do
| 1 | Check Confirm glucose; check blood ketones if available, or urine ketones. |
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| 2 | Give fluids Use small frequent sips. Choose sugar-free or carbohydrate-containing fluids according to |
|---|---|
| glucose and the sick-day plan. |
| 3 | Give correction insulin Use the written correction/ketone plan. With pump failure, correction may |
|---|---|
| need injection by pen/syringe. |
| 4 | Recheck Repeat glucose and ketones in 1-2 hours or as directed. |
|---|
GET URGENT HELP
Moderate/large urine ketones, blood ketones ≥1.5 mmol/L, persistent vomiting, breathing difficulty, severe abdominal pain, dehydration, drowsiness, or rising ketones despite insulin require urgent diabetes-team/emergency assessment.
CHAPTER 9
9. Sick-day management
THE GOLDEN RULE
Never stop basal insulin. Illness may increase insulin needs even when the child eats less. Contact your diabetes team early for individualized dose advice.
| 1 | Monitor more often Check glucose every 2-4 hours, including overnight if advised. Confirm unexpected |
|---|---|
| CGM values with a meter. |
| 2 | Check ketones Check every 2-4 hours while ill and whenever glucose is high; follow blood- or urine- |
|---|---|
| ketone instructions. |
| 3 | Continue insulin Continue basal insulin and give meal/correction/ketone insulin according to the written |
|---|---|
| plan. |
| 4 | Prevent dehydration Offer frequent small sips. If glucose is high, use sugar-free fluids; if low/normal |
|---|---|
| and not eating, use carbohydrate-containing fluids as advised. |
| 5 | Treat the illness Use age-appropriate medicines advised by the child’s clinician. Check labels for sugar |
|---|---|
| and interactions. |
CHAPTER 9
9. Sick-day action sheet
| Every 2-4 hours record | Result / action |
|---|---|
| Time | ____________________________ |
| Glucose | ____________________________ |
| Blood or urine ketones | ____________________________ |
| Insulin given | ____________________________ |
| Fluids / carbohydrate taken | ____________________________ |
| Temperature and symptoms | ____________________________ |
Call the diabetes team urgently if
Ketones are moderate/large, blood ketones are ≥1.5 mmol/L, or ketones are rising/not clearing. The child cannot keep fluids down, has repeated vomiting or has signs of dehydration. Glucose stays high despite correction insulin, or repeated hypoglycemia occurs. You are unsure how much insulin or fluid to give.
Go to emergency care now if
Breathing is deep/rapid, the child is very drowsy/confused, has severe abdominal pain, or looks seriously unwell. There is a seizure, unconsciousness, severe hypoglycemia not responding to glucagon, or you cannot safely manage
at home.
KEEP READY
Meter + strips • blood/urine ketone strips • insulin and delivery supplies • glucagon • rapid glucose • thermometer • oral rehydration fluids • diabetes-team and emergency numbers
My individualized diabetes plan
| Plan item | Write the child-specific instruction |
|---|---|
| Usual glucose target | ________________________________________ |
| Low-glucose treatment amount | ________________________________________ |
| Glucagon product and dose | ________________________________________ |
| When to check ketones | ________________________________________ |
| Correction factor / plan | ________________________________________ |
| Ketone insulin plan | ________________________________________ |
| Sick-day contact number | ________________________________________ |
| Emergency number | ________________________________________ |
Sources and clinical note
This family education booklet was developed from the supplied “Diabetes Information Booklet” and “Diet in Type 1 DM” materials, then clinically aligned with current ISPAD consensus guidance.
Core references
ISPAD Clinical Practice Consensus Guidelines 2024: Glycemic Targets. ISPAD Clinical Practice Consensus Guidelines 2024: Glucose Monitoring. ISPAD Clinical Practice Consensus Guidelines 2024: Insulin and Adjunctive Treatments in Children and Adolescents
with Diabetes. ISPAD Clinical Practice Consensus Guidelines 2024: Diabetes Technologies - Insulin Delivery. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes Education in Children and Adolescents. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional Management in Children and Adolescents with
Diabetes. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and Management of Hypoglycemia in Children and
Adolescents with Diabetes. ISPAD Clinical Practice Consensus Guidelines 2022: Sick Day Management in Children and Adolescents with
Diabetes.
Prepared as an educational draft • August 2026